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Stillbirth
| ICD9 = | ICDO = | OMIM = | MedlinePlus = 002304 | eMedicineSubj = search | eMedicineTopic = Stillbirth | MeshID = | }} A stillbirth occurs when a fetus which has died in the womb or during labour or delivery exits its mother's body. The term is often used in distinction to live birth or miscarriage. Some sources reserve the term "stillbirth" for a fetus which has died after reaching mid-second trimester to full term gestational age. For example, in the United Kingdom, "stillbirth" is used to describe an infant delivered without life after 24 weeks gestation. The sources that use this definition tend to use the term "miscarriage" if the death occurs earlier in development. In contrast, other sources use the term "stillbirth" regardless of the stage of fetal development. Human stillbirth Causes The causes of a large percentage of human stillbirths remain unknown, even in cases where extensive testing and autopsy have been performed. The term used to describe these is sudden antenatal death syndrome or SADS. In cases where the cause is known, some possibilities of the cause of death are: *bacterial infection *birth defects *chromosomal aberrations *growth retardation *Intrahepatic Cholestasis of Pregnancy *maternal diabetes or high blood pressure *maternal consumption of nicotine, alcohol, recreational drugs (excluding cannabisFried, P.A. (2002). The consequences of marijuana use during pregnancy: a review of the human literature.), or pharmaceutical drugs contraindicated in pregnancy *postdate pregnancy *placental abruption *physical trauma *radiation poisoning *Rh disease *umbilical cord accidents Prenatal diagnosis A decrease or cease of fetal activity may be an indication of fetal distress or death, though it is not entirely uncommon for a healthy fetus to exhibit such changes, particularly near the end of a pregnancy when there is considerably little space in the womb for the fetus to move about. Still, medical examination, including a nonstress test, is recommended in the event of any change in the strength or frequency of fetal movement, especially a complete cease; most midwives and obstetricians recommend the use of a kick chart to assist in detecting any changes. Fetal distress or death can be confirmed or ruled out via fetoscopy/doptone, ultrasound, and/or electronic fetal monitoring. If the fetus is alive but inactive, extra attention will be given to the placenta and umbilical cord during ultrasound examination to ensure that there is no compromise of oxygen and nutrient delivery. Prenatal maternal treatment An in utero fetal death does not present an immediate health risk to the mother and labour will usually begin spontaneously after two weeks, so the mother may choose to wait and deliver the child naturally. After two weeks, the mother is at risk of developing blood clotting problems, and induction is recommended at this point. In many cases, the mother will find the idea of carrying a dead fetus emotionally traumatizing and will elect to be induced. Cesarean delivery is not recommended unless complications develop during vaginal birth. Impact on family As with any loss or traumatic event, particularly those involving one's offspring, a grieving period is to be expected; the mother often experiences a heightened sense of grief after a stillbirth, due to her close proximity to the child at the time of death. Grief reactions can range from normal depression, including misplaced guilt and/or blame, to psychosis, such as experiencing phantom fetal movement or newborn crying, inability to face taking down a nursery, "replacement child syndrome" in which the next child is saddled with the expectations of the "ideal" first child, or "vulnerable child syndrome" in which all subsequent children are seen as fragile and prone to harm or illness. Everyone responds differently to grief and loss: some individuals cope better with their grief if presented with the option of spending personal time with their child, sometimes bathing, dressing, and taking photos of them; and many parents wish to keep memorabilia such as clothing, hospital bracelets, and/or footprints/ultrasound photos. Often, missing these opportunities (due to traumatic stress, illness, or other factor) or being denied them can compound the loss, and it is important that these options be expressly offered or suggested by the health care providers or others involved with the family. Many hospitals provide families with a "memory box"; these are donated to hospitals, primarily by local organizations concerned with stillbirth and child loss. The spiritual needs of the bereaved parents are also very important. If the family has other children, developmental psychology generally suggests that: giving them the opportunity to meet their stillborn sibling allows them to experience the child as a real person and helps them understand death; it is natural for children to ask many questions, which should be answered openly and honestly, and they should be encouraged to share their thoughts and feelings, especially if they seem to be withdrawing; children tend to apply literal interpretations to what they are told, so accurate terminology should be used when discussing the stillborn child, death, and similar subjects, so that the child does not become confused or develop phobias (such as developing a sleeping phobia when a stillborn is referred to as "asleep") Families may require assistance and/or options in regard to: *Early hospital arrangements *Funeral plans *Crisis intervention, grief counseling, and referral to other support services Prevalence Stillbirth is a relatively common, but often completely random occurrence. Based on statistical data, it has been found that the mean stillbirth rate in the United States is approximately 1 in 115 births, which is roughly 26,000 stillbirths each year, or one every 20 minutes on the average. In developing countries where medical care can be substandard or completely unavailable, this rate is much higher. In Australia the stillbirth rate is approximately 1 in every 200 babies. In England, Wales and Northern Ireland the stillbirth rate is 1 in 200 babies. In Scotland the stillbirth rate is 1 in 167 babies. (From The National Statistical Office and other sources.) Legal definitions of stillbirth Australia In Australia any stillborn fetus weighing more than 400 grams, or more than 20 weeks in gestation, must have its birth registered. Should the parents of a stillborn child have children later that live, when registering the newer children's birth they must add SB beside the name of the stillborn child. Canada Beginning in 1959, "the definition of a stillbirth was revised to conform, in substance, to the definition of fetal death recommended by the World Health Organization." Statistics Canada (“Canada’s National Statistical Agency”), History, Vital Statistics - Stillbirth Database, in Vital Statistics – Stillbirth Database. United Kingdom In the United Kingdom, stillbirths must be registered by law. The Stillbirth Definition Act (1992) requires that any ‘child’ expelled or issued forth from its mother after the 24th week of pregnancy that did not breathe or show any other signs of life be registered as a stillbirth. This must be done within 42 days and a Stillbirth Certificate is issued to the parent(s).http://www.gro.gov.uk/gro/content/stillbirths/ United States In the United States, there is no standard definition of the term 'stillbirth'. The Centers for Disease Control and Prevention collects statistical information on "live births, fetal deaths, and induced termination of pregnancy" from 57 reporting areas in the United States. Each reporting area has different guidelines and definitions for what is being reported; many do not use the term "stillbirth" at all. The federal guidelines suggests (at page 1) that fetal death and stillbirth can be interchangeable terms. The CDC definition of "fetal death" is based on the definition promulgated by the World Health Organization in 1950: :"Fetal death" means death prior to the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy. The death is indicated by the fact that after such expulsion or extraction, the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps. The federal guidelines recommend reporting those fetal deaths whose birth weight is over 350g, or those over 19 weeks gestation. Forty-one areas use a definition very similar to the federal definition, thirteen areas use a shortened definition of fetal death, and three areas have no formal definition of fetal death. Only 11 areas specifically use the term 'stillbirth' , oftentimes synonymously with fetal death, however they are split between whether stillbirths are "irrespective of the duration of pregnancy", or whether some age or weight constraint is applied. See also Childbirth *Live birth *Perinatal death **Intrapartum death **Neonatal death ***Sudden infant death syndrome *Abortion **Elective abortion ***Anomalous pregnancy ****Ectopic pregnancy ****Molar pregnancy **Spontaneous abortion *Maternal death Footnotes External links *The Wisconsin Stillbirth Service Program (WiSSP), a branch of the University of Wisconsin-Madison's Clinical Genetics Center. One of the foremost authorities on the causes of stillbirth and responsible for many stillbirth evaluation protocols, including the widespread use of the Kleihauer-Betke test in deciding whether Rh disease is to blame for a stillbirth. * First-person story of one woman's journey through stillbirth Grieving resources *MISS Foundation support site for those bereaved of a child and advice for professionals on their support. * LossAwareness.com - An informational website for bereaved parents, family members and friends (non-obtrusive mention of God) *A website offering resources for anyone who has been affected by stillbirth *KotaPress Loss Journal section on Stillbirth *Ryland's Hope--information and financial resources for those grieving the loss of an infant * The Forgotten Grief: Mourning, Grief and Bereavement at Loss in the perinatal Period (from a Judeo-Christian perspective) * 'I Spoke With My Child' : A beautiful, comforting & heart-stirring presentation - for every parent who has lost a child (from a Christian perspective) *A Small Victory Providing Loss Kits to parents of children lost through miscarriage, stillbirth and neonatal loss as well as training nurses on how to properly deal with these types of loss. A Small Victory will also connect families with one on one or group counseling. *SANDS AUSTRALIA providing support, information & counselling for bereaved parents & families *Now I Lay Me Down To Sleep infant bereavement photography provides free services of local professional photographers to parents who want to preserve respectful images of their baby. *Angel Teddy Bear Foundation their purpose is to deliver teddy bears to hospitals that are in turn given to parents of stillborn children, miscarriages and neonatal loss. Activism/Prevention *MISS Foundation an activist site of the MISS Foundation for parents of stillborn infants. *National Stillbirth Society an activist group of parents for stillbirth education. *Preferred Pregnancy Protocol for minimizing the risk of stillbirth due to cord accidents. *State of Florida Now Issues Birth Certificates for Parents of Stillborn Children *Washington State MISSing Angels Bill Blog Factual/Reference *Pregnancy Institute founded by Dr. Jason H. Collins, OB/GYN specializes in umbilical cord research *March of Dimes: Quick reference and fact sheet *Investigating perinatal death: a review of the options when autopsy consent is refused. *Stillbirth at h2g2 - written by a bereaved mother Category:Obstetrics